IL1RN Variation Influences Both Disease Susceptibility and Response to Recombinant Human Interleukin-1 Receptor Antagonist Therapy in Systemic Juvenile Idiopathic Arthritis.
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Arthur Victoria L, Shuldiner Emily, Remmers Elaine F, Hinks Anne, Grom Alexei A, Foell Dirk, Martini Alberto, Gattorno Marco, Özen Seza, Prahalad Sampath, Zeft Andrew S, Bohnsack John F, Ilowite Norman T, Mellins Elizabeth D, Russo Ricardo, Len Claudio, Oliveira Sheila, Yeung Rae S M, Rosenberg Alan M, Wedderburn Lucy R, Anton Jordi, Haas Johannes-Peter, Rösen-Wolff Angela, Minden Kirsten, Szymanski Ann Marie, INCHARGE Consortium, Thomson Wendy, Kastner Daniel L, Woo Patricia, Ombrello Michael J
Аннотация
METHODS: Single-nucleotide polymorphisms (SNPs) from 11 previously reported systemic JIA risk loci were examined for association in 9 populations, including 770 patients with systemic JIA and 6,947 controls. The effect of systemic JIA-associated SNPs on gene expression was evaluated in silico in paired whole genome and RNA sequencing data from the lymphoblastoid cell lines (LCLs) of 373 European subjects from the 1000 Genomes Project. Responses of systemic JIA-associated SNPs to anakinra treatment were evaluated in 38 US patients for whom treatment response data were available.
RESULTS: We found no association between the previously reported 26 SNPs and systemic JIA. Expanded analysis of the regions containing the 26 SNPs revealed only 1 significant association: the promoter region of IL1RN (P < 1 × 10-4 ). Systemic JIA-associated SNPs correlated with IL1RN expression in LCLs, with an inverse correlation between systemic JIA risk and IL1RN expression. The presence of homozygous IL1RN high expression alleles correlated strongly with a lack of response to anakinra therapy (odds ratio 28.7 [95% confidence interval 3.2-255.8]).
CONCLUSION: In our study, IL1RN was the only candidate locus associated with systemic JIA. The implicated SNPs are among the strongest known determinants of IL1RN and interleukin-1 receptor antagonist levels, linking low expression with increased systemic JIA risk. Homozygous high expression alleles predicted nonresponsiveness to anakinra therapy, making them ideal candidate biomarkers to guide systemic JIA treatment. This study is an important first step toward the personalized treatment of systemic JIA.